Tools for More Accurate Inpatient Cost Estimates with HCUP ...

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We defined 746 MS-DRG categories and 262 CCS categories. We calculated relative cost andAFs for 449 distinct MS-DRG categories and 227 distinct CCS categories. For the remaining297 MS-DRG and 35 CCS categories, we could only calculate a group AF.The resulting AFs ranged between 0.815 and 1.383 for MS-DRGs (0.864 and 1.396 for CCScategories). However, 87.5% of distinct AFs for MS-DRGs were between 0.90 and 1.10; 82.8%of distinct AFs were within this range for CCS categories. Both of the grouped AFs for the MS-DRG and CCS categories were in the range of 0.90 and 1.10. If we included the groupedcategories, 92.5% of AFs for MS-DRGs and 85.1% of AFs for CCS categories were between0.90 and 1.10, respectively.Highest AFs (CCS categories)The following 10 categories had the highest AFs among CCS categories:• Delirium, dementia, and amnesia; other cognitive disorders• Umbilical cord complication• Obstetric-related trauma to perineum and vulva• Forceps delivery• Mood disorders• Normal pregnancy and/or delivery• Adjustment disorders• Schizophrenia and other psychotic disorders• Hemolytic jaundice and perinatal jaundice• Attention-deficit, conduct, and disruptive behavior disorders.Lowest AFs (CCS categories)The following 10 categories had the lowest AFs among CCS categories:• Nonspecific chest pain• Transient cerebral ischemia• Abdominal pain• Coagulation and hemorrhagic disorders• Conditions associated with dizziness or vertigo8
• Appendicitis and other appendiceal conditions• Syncope• Headache; including migraine• Maintenance chemotherapy; radiotherapy• Open wounds of head, neck, and trunk.Cases with high AFs (above 1.0) tended to involve long stays for mental conditions andcomplications from deliveries. Cases with low AFs (below 1.0) included patients requiringextensive diagnostic services such as imaging, laboratory testing, drugs, and select surgeries.ConclusionsIn general, department-specific CCRs are more accurate for estimating the cost of a hospitalstay than hospital-wide CCRs. However, not all states ask hospitals to report detailed chargesfor every case, and not all hospitals have usable CMS accounting reports. It is possible to forma more accurate estimate of cost by DRG by applying an adjustment to the hospital-wide CCR.The adjustment is derived by DRG from hospitals in the states with complete data. Theadjustment by DRG can be applied to every relevant case in any hospital with a hospital-wideCCR.For the vast majority of DRGs (much more than is needed to get legislation through the U.S.Congress), the AF is between 0.90 and 1.10. The relatively small number of exceptions may beimportant in individual studies. We provide our latest estimates of AFs in Appendices as anoption to researchers concerned about the accuracy of cost estimation.9
Page 1 and 2: HCUP Methods Series
Page 3 and 4: TABLE OF CONTENTSEXECUTIVE SUMMARY
Page 5 and 6: EXECUTIVE SUMMARYBackgroundThe Agen
Page 7 and 8: possible to form a more accurate es
Page 9 and 10: Cluster #ClusterAbbreviationCMSCost
Page 11: • A case was considered invalid i
Page 15 and 16: UB-04 Revenue CodeCluster041x: Resp
Page 17 and 18: CHGnDescription13UB-04RevenueCodesC
Page 20 and 21: CHGn Revenue Codes DescriptionClust
Page 22 and 23: CHGn Description UB-92 Revenue Code
Page 24 and 25: CHGn Description UB-92 Revenue Code
Page 26 and 27: DRGDischargesRelativeCostBased onCo
Page 50 and 51: Appendix C: Cost Adjustment Factors
Page 52 and 53: DXCCS1DischargesRelative CostBased
Page 58: Appendix D: ErrataThis report, The

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